What is the role of intranasal mometasone (corticosteroid) and olopatadine (antihistamine) in treating post nasal drip syndrome?

From the Guidelines

Intranasal mometasone and olopatadine are effective treatments for post-nasal drip syndrome, with complementary mechanisms of action, as supported by the most recent and highest quality study 1.

Mechanism of Action

Mometasone furoate, a corticosteroid nasal spray, reduces inflammation in the nasal passages by suppressing the production of inflammatory chemicals, decreasing mucus production, and reducing nasal congestion. Olopatadine, an antihistamine nasal spray, blocks histamine receptors to reduce allergy symptoms that can trigger post-nasal drip.

Dosage and Administration

The typical dosage of mometasone is 1-2 sprays in each nostril once daily, while olopatadine is usually administered as 2 sprays per nostril twice daily.

• It is essential to clear nasal passages before application.
• Aim the spray toward the outer wall of the nostril.
• Continue treatment as prescribed even after symptoms improve.

Efficacy and Combination Therapy

The combination approach is particularly effective because it addresses both the inflammatory and allergic components of post-nasal drip syndrome, providing more comprehensive symptom relief than either medication alone, as noted in studies comparing combination therapy with monotherapy 1.

• Mometasone takes several days to reach full effectiveness.
• Olopatadine provides more immediate relief.
• The combination of an intranasal corticosteroid and an intranasal antihistamine may be recommended for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, as suggested by the 2017 joint task force on practice parameters 1.

From the Research

Role of Intranasal Mometasone and Olopatadine in Treating Post Nasal Drip Syndrome

• The combination of intranasal mometasone (a corticosteroid) and olopatadine (an antihistamine) has been studied for its efficacy in treating allergic rhinitis, which often presents with post nasal drip syndrome 2, 3, 4, 5.
• A study published in 2003 compared the effects of olopatadine ophthalmic solution, mometasone furoate monohydrate nasal spray, and fexofenadine hydrochloride tablets using the conjunctival and nasal allergen challenge models, and found that the nasal spray was most effective for nasal symptoms 6.
• More recent studies have investigated the efficacy and safety of a novel intranasal formulation combining olopatadine and mometasone furoate, and have found it to be effective in providing rapid symptom relief and good tolerability for patients with allergic rhinitis 2, 4, 5.
• An observational real-world clinical study found that patients using the olopatadine/mometasone furoate combination nasal spray had higher treatment satisfaction and regarded sensory attributes as more important compared to those using an azelastine/fluticasone combination nasal spray 3.
• The onset of action of the olopatadine/mometasone combination nasal spray has been found to be rapid, with significant improvements in nasal symptom scores occurring within 10 minutes of dosing 4.

Efficacy and Safety of Intranasal Mometasone and Olopatadine

• The efficacy and safety of twice-daily and once-daily olopatadine-mometasone combination nasal spray have been evaluated in several studies, and have been found to be well tolerated and effective in providing statistically significant and clinically meaningful improvements in nasal symptom scores 4, 5.
• The combination nasal spray has been found to be effective in reducing nasal congestion, rhinorrhea, and sneezing, and has also been found to improve quality of life for patients with seasonal allergic rhinitis 5.
• The safety profile of the olopatadine/mometasone combination nasal spray has been found to be similar to that of the individual components, with the most common adverse events being mild to moderate in severity 4, 5.

Clinical Implications

• The use of intranasal mometasone and olopatadine in combination may be a useful treatment option for patients with post nasal drip syndrome, particularly those with allergic rhinitis 2, 3, 4, 5.
• The rapid onset of action and good tolerability of the olopatadine/mometasone combination nasal spray make it a convenient and effective treatment option for patients with seasonal allergic rhinitis 4, 5.
• Further studies are needed to fully evaluate the efficacy and safety of the olopatadine/mometasone combination nasal spray in patients with post nasal drip syndrome, and to compare its effectiveness with other treatment options 2, 3, 4, 5.